A metacognitive analysis of craving: implications for treatment

Cravings and urges are a common component of clinical interventions for substance use and dependence. The conceptual status of this variable remains uncertain, however. Cognitive, conditioning, pharmacological, and biological explanatory models of craving have been developed in recent years. In this article a metacognitive analysis of craving is outlined in which cravings are construed as metacognitions (i.e., statements about other cognitions). In a metacognitive analysis, craving for psychoactive substances is an indication that the individual is experiencing a cognitive event (i.e., thought, feeling, memory, image, sensation) that is aversive or unpleasant. Consumption of a psychoactive substance is a means of self-regulating such cognitive events. Identifying the cognitive experience implicit in the expression of cravings can inform the clinician of the client's deficiencies in cognitive self-regulation and other coping skills. An illustrative example of a metacognitive analysis is presented.